Search

Predictions for future growth of ESRD prevalence. The European Union (EU) has 15 member countries and a total population of 373 million. In 1995 the incidence of new patients starting renal replacement therapy (RRT) was 120 per million population (pmp). The overall incidence of death was 67 pmp and the total number of patients alive on treatment was 644 pmp. During this year, the pool of patients expanded by 8.2%. These overall figures concealed large differences between countries. For example, the incidence of new patients varied from 69 pmp to 163 pmp, the stock of patients on RRT varied from 444 pmp to 773 pmp and the expansion rate of the pool of RRT patients varied form 2.3% to 13%. On the basis of these figures, it is likely that the stock of patients will continue to increase steadily, but at a slowly diminishing rate, to reach a figure of 1000 pmp by 2001 or 2002. [ABSTRACT FROM AUTHOR]

Renal replacement therapy for diabetic end-stage renal disease: Data from 10 registries in Europe (1991–2000).Background.There is concern about the rising prevalence of type 2 diabetes mellitus and of the resultant nephropathy. This study uses data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry to provide information on the epidemiology and outcome of renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetic nephropathy (DN).Methods.Data from the following 10 registries: Austria, French-speaking Belgium, Denmark, Finland, Greece, Norway, Scotland (UK), Catalonia (Spain), Sweden, and The Netherlands were combined. Average annual changes (%) were estimated by Poisson regression. Analyses of mortality were performed by Cox regression.Results.An increase in patients with type 2 DN entering RRT has been observed (+11.9% annually,P<0.05), while large differences in RRT incidence in this disease continue to exist between countries in Europe. There was a reduction in mortality during the first 2 years on dialysis therapy among patients with type 2 DN (AHR 0.96, 95%CI 0.94–0.97 annually). The mortality among transplant recipients decreased for both type 1 DN and nondiabetic ESRD (non DN) within the 1995–1998 cohort (type 1 DN: AHR 0.49, 95% CI 0.35–0.68; non DN: AHR 0.79, 95% CI 0.69–0.90) compared to the 1991–1994 cohort.Conclusion.This report has shown that during the last decade there has been a marked increase in the incidence of RRT for type 2 DN. Survival analysis showed that over the period 1991–1999 the mortality rates of all dialysis patients and of type 1 diabetic and nondiabetic renal transplant recipients have fallen. [ABSTRACT FROM AUTHOR]

Early graft function and patient survival following cadaveric renal transplantation. Background. The influence of events that occur early following renal transplantation such as delayed graft function (DGF) and acute rejection on long-term graft survival has been widely reported, but its association with patient survival has received less attention. Methods. We studied 589 patients who received their first cadaveric transplants between 1984 and 1993, all of whom received cyclosporine-based immunosuppression and who had a median follow-up of seven years. The following factors were identified, and both univariate and multivariate analyses were used to determine their association with long-term patient and graft survival: age, sex, duration of pretransplant dialysis, primary renal disease, immediate graft function (IGF), DGF, primary nonfunction (PNF), acute rejection, and serum creatinine at 3, 6, and 12 months. Results. Patients with PNF had a poorer survival than those with DGF and IGF (P = 0.01), but there was no difference in survival between DGF and IGF (P = 0.54). Good graft function (serum creatinine of less than 200 μmol/liter) at three months was predictive of better long-term patient survival (P = 0.03). Other factors associated with poor patient outcome were older age, diabetes, adult polycystic kidney disease, male gender, and acute rejection. Cardiovascular disease was the most common cause of death (51.8%). Good graft function at three months (P < 0.001) and an absence of rejection episodes (P = 0.01) were associated with better graft survival. Conclusion. Patients with poor levels of early graft function (but not DGF) and those with either acute rejection episodes or early graft loss are at an increased risk of early death. These high-risk groups should be targeted for interventional studies in an attempt to improve patient survival. [ABSTRACT FROM AUTHOR]